Doctors' leaders are facing a challenge from senior medics who claim they have been too quick to accept the government's NHS shakeup and should instead "mobilise" to thwart it.
More than 100 doctors, including 20 professors, have signed an open letter in the British Medical Journal, criticising the leadership of the British Medical Association, the doctors' union.
They claim the BMA should abandon its "failed" policy of "critical engagement" with ministers over plans that will "destroy" the NHS, and instead withdraw from discussions with health secretary Andrew Lansley to fight his reforms.
They write: "The NHS really is in your hands. We understand the pressures you are under, but now is the time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation."
Fighting the changes is "a great opportunity for the BMA to achieve redemption for its opposition to the inception of the NHS in 1948," they add. The letter is addressed to BMA chairman Dr Hamish Meldrum, a GP; Dr Laurence Buckman, who heads its influential GPs' committee; and the other members of it.
Among the signatories are three members of the BMA council, its 33-strong ruling body, and leading doctors in fields such as cancer, children's health and emergency medicine. They also include GPs, whom Lansley insists will benefit from his plan to hand £80bn of NHS funding to family doctors in England so that they can commission services on their patients' behalf.
The letter was organised by Dr Clive Peedell, a consultant clinical oncologist at the James Cook university hospital in Middlesbrough, who is on the BMA council, as are co-signatories Jacky Davis, co-chair of the NHS consultants' association, and men's health expert Professor Ian Banks.
The doctors add that it is "remarkable" that the BMA had decided not to hold a special meeting to allow its full membership to air their views, despite Lansley's proposals being what the King's Fund health thinktank has called "the most radical restructuring of the NHS since its inception".
As a result, they say: "The BMA has no mandate from the wider membership to continue with the 'critical engagement' policy … The association has effectively sent a message to the profession that the [government's NHS reform] white paper is a done deal."
Meldrum rejected the criticisms, saying that the BMA, after several debates in its council, had welcomed some key aspects of Lansley's plans but had "real concerns" about others, "including the speed at which the changes are being rushed through and the dangers of market-based competition in the NHS".
The BMA plans to increase its lobbying ahead of the publication of the health bill, expected later this month, and will "continue to forcefully represent members' concerns as the government's proposals move to the next stage".
John Healey, the shadow health secretary, said the letter was "evidence of the pressure mounting on Lansley, and the growing criticism of his plans for a high-risk internal reorganisation of the NHS".